MEDICARE: SCOOTERS AMERICA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010139074	OTHER	ID	REGENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8P038	OTHER	ID	BC OF IDAHO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659382463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOOTERS AMERICA LLC

Provider Business Mailing Address
First Line	:	1640 E SCHNEIDMILLER AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-7065
Country	:	US
Telephone Number	:	208-773-8448
Fax Number	:	866-821-5201

Provider Business Practice Location Address
First Line	:	1640 E SCHNEIDMILLER AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-7065
Country	:	US
Telephone Number	:	208-773-8448
Fax Number	:	208-416-2713

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFREY MATUKEWICZ
Credential	:
Telephone Number	:	423-756-2268

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	04/14/2021

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Directions to “SCOOTERS AMERICA LLC ” Practice Location

Language	Start Address	Practice Location

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